Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Implemented Alone

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine whether park, trail, and greenway infrastructure improvements increase physical activity when they are implemented without additional interventions. Evidence was considered insufficient because changes in physical activity were inconsistent. Studies did find meaningful increases in the number of people using parks, trails, and greenways following infrastructure improvements. CPSTF finds, however, that the economic benefits exceed the cost for these interventions.

CPSTF recommends park, trail, and greenway infrastructure interventions when combined with additional interventions.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Park, Trail, and Greenway Infrastructure Interventions to Increase Physical Activity are available in The Community Guide Collection on CDC Stacks.

Intervention

Park, trail, and greenway infrastructure interventions improve the built and natural environments by creating or enhancing public locations for physical activity, relaxation, social interaction, and enjoyment. Locations include the following:

  • Parks designated public areas that often combine greenery with paths, facilities for physical activity and recreation, and places for relaxation and social interaction
  • Trails and Greenways routes for walking, hiking, or cycling in urban, suburban, or rural areas (e.g., “rails to trails” conversion projects). These may involve street conversions that provide opportunities for walking and cycling (most often in urban areas).

About The Systematic Review

The CPSTF finding is based on a systematic review of 38 studies (published through July 2020). Seventeen of the studies evaluated intervention that evaluated infrastructure interventions when used alone. Studies were identified from two sources:

  • Studies included in a broader systematic review published in 2019 (Hunter et al., 12 studies, search period through August 2016)
  • Studies identified in an update search (5 studies, search period August 2016 through July 2020)

The systematic review was conducted on behalf of CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to physical activity and the built environment.

Study Characteristics

  • Study designs included randomized controlled trials (1 study), other designs with a concurrent comparison group (9 studies), and before-after without control (7 studies)
  • Park infrastructure improvements noted in the studies included a new park (1 study), added new structures (3 studies), renovations to existing structures (7 studies), and a combination of new construction and renovations (2 studies)
  • Trail and greenway infrastructure improvements included a new route (1 study) and extensions to existing routes (2 studies)

Summary of Results

The systematic review included 17 studies that evaluated infrastructure improvements when used alone. Physical activity outcomes reported in the included studies could not be combined to provide summary effect estimates.

  • Ten studies examined changes in moderate-to-vigorous physical activity in the park, trail, or greenway and observed inconsistent effects
  • Five studies evaluated changes in total physical activity and observed inconsistent effects
  • Six studies examined other measures of physical activity and observed inconsistent effects
  • Nine studies examined changes in use of the park, trail, or greenway (regardless of the level of physical activity) and observed a median increase of 32.1%

Summary of Economic Evidence

Summary of systematic review of economic evidence from a societal perspective that shows the economic benefits exceed the cost are available at Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Combined with Additional Interventions.

Applicability

Applicability of this intervention across different settings and populations was not assessed because CPSTF did not have enough information to determine if the intervention works.

Evidence Gaps

  • Do these interventions increase physical activity?
  • Which characteristics of infrastructure improvements are effective in increasing physical activity and use?
  • Are these interventions effective for improving other health and health-related outcomes including the following?
    • Fitness
    • Mental health including measures of anxiety, depression, and well-being
    • Perceptions of social cohesion and connectiveness
    • Injuries
    • Quality of life
  • How effective are these interventions across different communities and populations?
  • How effective are park, trail, and greenway infrastructure improvements alone in reducing perceptions of crime and improving perceptions of safety among members of the community?
  • Which interventions, or combinations of interventions, are most effective in addressing barriers to use of parks, trails, and greenways among the following populations?
    • Communities with lower incomes
    • Older adults
    • People with disabilities
  • What is the cost-effectiveness of park, trail, and greenway interventions?
  • What are the economic effects of neighborhood displacement on residents from historically disadvantaged racial and ethnic populations and populations with lower incomes?

Implementation Considerations and Resources

Implementation Considerations and Resources are available at Physical Activity: Park, Trail, and Greenway Infrastructure Interventions when Combined with Additional Interventions.